To better meet the needs of our patients and our referral physicians we have expanded to a new facility dedicated exclusively to the treatment of pain. Patients are now able to see thier physician and receive their treatment in one convenient location at the Swan Corporate Center.

Tucson Surgery Center has an off-site interventional facility for Pain Management. Our goals, through
several modes of intervention, is to help our patients decrease their pain and suffering and
help them restore optimal quality to life. Pain is a complex medical problem that can have a
severe impact on peoples physical and mental well-being.

Our facility offers 4 pre-procedure rooms, 3 procedure rooms plus 6 recovery bays. We are equipped to perform fluoroscopy
(x-ray) guided procedures. Our patients are usually scheduled for treatment after an initial
consultation with an anesthesiologist specializing in pain management. Treatment usually
consists of several procedures over the course of three to six months, which is customized to specific individual needs.

Where is the epidural space?
The membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Spinal nerve roots travel through the epidural space. Inflammation (swelling) of these nerve roots may cause pain in various regions of your spine and radiate to other parts of your body.

What is an Epidural Steroid Injection?
An epidural steroid injection is an injection of a long lasting steroid (like “cortisone”) in the epidural space. The procedure is performed using a contrast dye under C-Arm fluoroscopy (x-ray guidance) to ensure correct location of the medication will be delivered. The epidural space can be reached through various regions of the spine, depending on where we are treating your pain: neck, mid-back, low-back, or tailbone, and by various approaches: intra-laminar (between the vertebrae), transforaminal (from either side of your spine), or caudal (tailbone).

What is the purpose of it?
The steroid injected reduces the inflammation and/or swelling of nerves and tissues in the epidural space. This may in turn reduce pain, tingling & numbness and other symptoms caused by nerve inflammation/irritation or swelling. It is especially good for leg pain from an irritated nerve root in the back, but sometimes works for back pain as well.

What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The most common side effect is pain at the injection site and lower back or neck, which is temporary. The other risks are very rare and include spinal puncture with headaches, infection, bleeding inside the epidural space with nerve damage, worsening symptoms etc. The other risks are related to the side effects of steroid. These include temporary weight gain, temporary increase in blood sugar (mainly in diabetics) and water retention.

Will the epidural steroid injection help me?
It is impossible to predict if the injection will indeed help you or not. Generally speaking, the patients who have “radicular symptoms” or “sciatica” (buttock and leg pain, numbness, tingling) respond better to the injections than the patients who have only back pain. Similarity, the patients who have not had pain for very long may respond much better than the ones with pain for more than six months.

How long does the injection take?
The injection takes approximately 5-7 minutes.

What is actually injected?
The injection consists of a mixture of either a local anesthetic (like lidocaine or bupivacaine) or the steroid medication (Depo-Medrol and/or Sarapin, Celestone or Kenalog) or both.

Will the injections hurt?>
The procedure involves inserting a needle through the skin and deeper tissues (like a tetanus shot). There is some discomfort involved. We use a very thin needle.

Will I be “put out” for this procedure?
The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

How is the injection performed?
It is done either lying on the stomach or occasionally sitting up. You are monitored with a blood oxygen-monitoring device. The skin is cleaned with anti-septic solution and then the procedure is performed. After the injection, you will be assisted to the recovery area.

How long will the effects of the medication last?
The steroid starts working in about two to three days and its pain relieving effects can last for several days, many months, or indefinitely.

What can I expect after the procedure?
In the first two days, you may have a “sore back or neck”. This is due to the procedure itself- the needle being inserted and the initial irritation from the steroid itself. You should start noticing pain relief from the steroid, starting the 3rd to 4th day as it is slow acting. You should be able to return to work the next day. The most common symptom you may feel is a sore back or neck.

How many injections do I need to have?
There are three possible responses to your 1st injection; complete relief, or no pain relief. If the 1st injection does not relieve your symptoms in about a week or two weeks, you will not have the same injection repeated. If you get partial relief we usually recommend you have a second one and possible third injection within 4-8weeks of the 1st injection. If you get complete relief but it wears off, we would offer you a repeat injection. In the 1st six months we generally do not perform more that three injections. This is because the medication injected lasts for about six months. If three injections have not helped much, if is very unlikely that you will get any further benefit from more injections. Also, giving more injections will increase the likelihood of side effects from the steroid.

A Facet joint is a small joint located in pairs on the back of your spine from the neck to the base of your spine. A Facet Joint injection is:

An injection of a local anesthetic into facet joints (needles on the right in Fig. 1are shown in position to inject into the three lower right facet joints) or,

An injection of local anesthetic around the nerves that supply the joint (the needles on the left in Fig. 1 are shown in position to inject anesthetic onto the nerves supplying two lower left lumbar facet joint) or,

An injection of local anesthetic into joints and around the nerves going to the joints together at the same time

What is the purpose of the procedure?

DIAGNOSTIC: 95% of facet injections are diagnostic injections. Only local anesthetic is injected into the joint and/or onto the nerves supplying the joint. This is a diagnostic test to see if the injected joints are causing your back or neck pain. The intent of the injections is to numb up the joint long enough to allow you to do activities that normally provoke your back or neck pain and to see if the pain occurs with those activities or not. You will be given a “pain log” to take home to monitor the level of your pain.

If the injected joints ARE causing your pain, then you will feel much less pain after the injection. Your pain log will reflect this.

If the injected joints are NOT causing your pain, you will notice no difference in the pain.

THERAPEUTIC: Rarely done. A small amount of steroid (usually Depo-Medrol) is added to the local anesthetic and the injection is made into the joint, not onto the nerves going to the joint. The intent is to reduce joint inflammation related to arthritis, such as an injection into the knee or shoulder joint can do when arthritis is severe. The results are temporary (2 weeks-6 months of pain relief).

What happens after the Diagnostic Facet Joint Injection?

There are special treatments available for painful facet joints; if the diagnostic injections(s) show that you have one or more painful facet joints, that is you felt less pain after the facet joint injection, there is a relatively simple procedure (radio-frequency (RF) lesioning) that can be done to make the painful joints numb long term. If the joints are NOT causing your pain, treatment has to be focused elsewhere, not on the joints. Finally, once we know that the joints are a cause of pain we may want to modify surgical treatment plans to include treatment of facet joint pain, should you ever need surgery.

Will the facet joint injection(s) help my pain?

Diagnostic injections: NO. They are not meant to help your pain; they are intended only to diagnose if your back or neck pain is coming from facet joints, and if so, which joint(s) are painful. If your pain goes away after the injection, it will return once the anesthetic wears off.Therapeutic injections: They are supposed to help, but it is impossible to know ahead of time if they will. The chance that they will is roughly 50%. However, unless the Dr. has specifically told you that he is doing a therapeutic injection, this does not apply to you. As mentioned earlier, 95% of facet injections are diagnostic.

Will I be “put out” for this procedure?

The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

What should I do after the procedure?

If sedation was used, you will NOT be able to drive or operate machinery until the following day. If no sedation was used, you should not drive for 2 hours after the injection. In the first 4-6 hours, you need to test the injection by doing things that usually provoke your back or neck pain. We do not want you to rest or take is easy right after the injection. If you are sore after the anesthetic wears off (and this can be normal for 1-2 days), avoid activity that hurts a lot for your own comfort.

Can I go to work the next day?

You should be able to work the next day. The most common thing you may feel is a sore back or neck.

Will the injection need to be repeated?

Diagnostic injections are usually done in sets of 2 injections on different days. It depends on how many joints need to be tested (based on the assessment of your pain by the Dr.).

What should I do with the Pain Log I am given?

For all diagnostic injections you will be asked to rate your pain every 30-60 minutes for 4-6 hours as outlined on the pain log. Rate only your typical pain, do not include soreness from the injection.
Specific instructions as to how to return the pain log is listed on the log.
Generally speaking, if your pain is relieved by the injection before you are discharged, we will book a return appointment for a follow-up procedure. If your pain is not relieved by the injection before you are discharged, a return appointment may be made for a follow-up consult to discuss other treatment options.

What about my pain medications?

On the day of your facet joint injection, DO NOT TAKE any short acting “as needed” pain medications such as: Percocet, Roxicet, Roxicodone, Oxycodone, Oxy IR, Vicodin, Lortab, Norco, Hydrocodone, Lyrica, Immediate release Morphine, Dilaudid, Codeine, Propoxyphene, Darvocet, Ibuprofen, Motrin, Naprosyn, Naproxen, Aleve, Tylenol, or any other over the counter remedies for back or neck pain.
WHAT IS OKAY TO TAKE: Your regular long acting pain medications such as: MS contin, Morphine ER, OxyContin, Oxycodone SR, Oxycodone 12 hr., Avinza, Kadian, and Methadone. We do not want you to be skipping these because this can cause withdrawl symptoms.
AFTER THE PROCEDURE: Take any medications that you usually take for pain if there is severe back or neck pain.

Greater and lesser Occipital block is an injection of local anesthetic next to the greater and lesser occipital nerves, which are located just beneath the scalp in the back of the head. Since these nerves are outside the skull, this block does not involve brain surgery.

What is the purpose of it?

The injection blocks both the greater and lesser occipital nerves. This block is useful in diagnosing and treating occipital neuralgia, relieving or reducing pain in the back of the head. The block may also be used to provide surgical anesthesia in the occipital region. The block may be done on either the left or right side of the back of the head, or both.

What is injected?

The injection consists of a local anesthetic (like lidocaine or bupivicaine). When treating occipital neuralgia or other painful conditions, steroid medication is sometimes added to the local anesthetic.

How long does the injection take and how is it performed?

The actual injection takes only a few minutes. It is done while you sit with your head bent forward and resting on a bedside table.

Will the injections hurt?

The procedure involves inserting a needle through the skin and deeper tissues (like a tetanus shot). There is some discomfort involved and you may hear a “rice krispie” sound. We use a very thin needle.

Will I be “put out” for this procedure

The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

What should I expect after the injection?

Immediately after the injection the back of your head may feel warm. In addition, you may notice that your pain may be gone or lessened considerably.

What should I do after the procedure?

We advise patients to take it easy for a day or so after this procedure. Perform normal activities as you can tolerate them.

Can I go to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the back of your head at the injection site.

How long will the effects of the medication last?

The local anesthetic wears off in a few hours. The steroid starts working in about 3-7 days and its effect can last for several days to a few months.

How many injections do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need two to four and some may need 10 or more. The response to such injections varies from patient to patient.

Will the Greater and lesser Occipital Block help me?

If you do not get relief from the injections, you may not have occipital neuralgia. This means that the pain in the occipital region may not be due to damage or dysfunction of the occipital nerves.
It is very difficult to predict if the injections(s) will help you out or not. The patients who are treated earlier during their illness tend to respond better than those who have this treatment after six months of symptoms do. Patients in the advanced stages of disease may not respond adequately. This in not permanent, but it may lessen the pain for several days, weeks, or months.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The most common side effect is pain-which is temporary. Since the scalp is highly vascular, having many tiny blood vessels near the surface of the skin, bleeding is common and to reduce it, an icepack may be used after the procedure. The other risk involves bleeding, infections, spinal block, and injection into blood vessels and surrounding nerves. Fortunately, the serious side effects and complications are uncommon.

An interscalene block is an approach to the brachial plexus (collection of nerves that control the shoulder and arm providing movement and sensory innervation). Nerve roots (C5-T1) lay between the anterior scalene and middle scalene muscles and form three trunks. Local anesthetics applied to these trunks can relieve compression of these nerves or numb the shoulder, arm, or hand. The injection site is between the neck and shoulder.

How long does the procedure take?

The block takes a few minutes and is precisely guided by a nerve stimulator. The nerve stimulator allows the Dr. to locate the nerves and thereby put local anesthetic next to the nerves providing the optimal blockage of these nerves.

Will the injections hurt?

The procedure involves inserting a needle through the skin and deeper tissues (like a tetanus shot). There is some discomfort involved. We use a very thin needle.

Will I be “put out” for this procedure?

The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

How is the injection performed?

You will be lying on your back with your arms at your sides and your head turned away from the side to be blocked. The area of the neck is palpated by the Dr. to feel the scalene muscles and other landmarks. The neck is prepped with a sterile antiseptic solution and a sterile drape is used. The skin is anesthetized with local anesthetic and a stimulating needle is passed into tissue surrounding the trunks of the nerves. The arm and shoulder is stimulated by the nerve stimulator and you will feel the muscles of your shoulder, arm hand and sometime chest, contract. When the exact stimulation is achieved, the stimulator is turned off and the local anesthetic is applied to the nerves. You will be asked if you hear a ringing in your ears, taste a metallic taste in your mouth, or feel dizzy. If you experience any of these sensations, you should tell the Dr. because this could mean the local anesthetic is leaking into structures other than the nerve. Once the block is completed your arm and shoulder will begin to get numb and you will be given a sling to protect your arm.

What can I expect after the procedure?

After the block your arm will be numb for several hours. You should take care not to come in contact with extremely hot or cold items because you will not be able to protect yourself from injuries from this. You should wear a sling while your arm is numb to protect over extension of your shoulder or elbow. A nerve called the phrenic nerve controls the expansion of the diaphragm and is blocked by the local anesthetic, since there are two phrenic nerves blocking one will not cause a problem, but you may notice a slight difference in your ability to take a deep breath following the block. If you get some relief from the block it will probably be repeated 2-3 times to see if you can get long-term relief from your pain.

Can I go to work the next day?

Unless there are complications, you should be able to return to your work the next day.

How long will the effects of the medication last?

The initial block will last for several hours and once these pathways of pain are blocked it may take hours, days, weeks, before the pain cycle is broken. The usual response is for it to decrease your pain to some degree and subsequent blocks to decrease it progressively more.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The most common side effect is pain which is temporary. Other risks involve bleeding, infections, spinal block and injection into blood vessels and surrounding nerves. Fortunately, the serious side effects and complications are uncommon.

Lumbar sympathetic block is an injection of local anesthetic in the “sympathetic nerve tissue”- the nerves which are a part of the Sympathetic Nervous System. The nerves are located on either side of the spine, in the back.

What is the purpose of it?

The injection blocks the sympathetic Nerves. This can help patients with “neuropathic pain”- pain from nerves. It can also help reduce swelling, color and sweating changes in the lower extremity and may improve mobility. It is done as part of the treatment of Complex Regional Pain Syndrome (CRPS), shingles and other conditions involving peripheral nerve injuries and leg swelling.

What is injected?

The injection consists of a local anesthetic (like lidocaine or bupivicaine).

How long does the injection take?

The actual injection takes only a few minutes.

Will the injections hurt?

The procedure involves inserting a needle through the skin and deeper tissues (like a tetanus shot). There is some discomfort involved. We use a very thin needle. There may be back and groin soreness afterward for up to several days.

Will I be “put out” for this procedure?

The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

What should I expect after the injection?

Your leg and foot may feel warm and dry. You may notice that your usual pain may be gone or considerable less. There may be some groin pain and low back pain from the injection, almost always very mild. There is no leg numbness or weakness unless some of the local anesthetic has leaked onto the lumbar nerves. This happens 10% of the time. If there is leg numbness or weakness, it will last 1-6 hours and you must be very careful, because the leg may not support your weight. Do not drive until the numbness is gone. In addition, report this to the nurse immediately before you are discharged, so arrangements can be made to prevent falls.

What should I do after the procedure?

You should have a ride home.We advise patients to take it easy the day of the procedure, stay off work that day. Perform normal activities as you can tolerate them. If your leg is numb, be very careful because it may not support your weight, and do not drive until numbness is gone. Some patients may go for immediate physical therapy, and this is okay. It is usually OK to return to work the following day.

Can I go to work the next day?

Unless there are complications, you should be able to return to your work the next day.

How long will the effects of the medication last?

The local anesthetic wears off in a few hours. However, the blockage of sympathetic nerves may last for many hours or days.

How many injections do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need two or more. The response to such injections varies from patient to patient.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The most common side effect is pain-which is temporary. The other risk involves bleeding, infections, spinal block, and injection into blood vessels and surrounding nerves. Some patients can get lightheaded when they stand up in the first six hours after the injection, so there should always be someone to assist you during this time frame.

This is a minimally invasive technique for relieving neck and back pain. It uses a specialized machine called a “radiofrequency machine” to block pain signals coming from painful joints in the spine.

Who is a candidate for this procedure?

Currently, Radio Frequency Lesioning is offered to patients with neck or back pain due to facet joint disease (the source of pain has to be proven to be originating from the facet joint(s) using test blocks).

What is Facet pain usually like?

Back pain from facet joints is usually worst with standing. Sometimes, patients with other spinal pathology have back pain in addition to their leg pain, and the back pain may be from painful joints. If so, this procedure may help. Facet pain does not generally cause pain to radiate down the leg past the knee. This is caused by a different spine problem.

Neck pain from facet joints is often worse on one side that the other and bad with turning the head to look over the shoulder. Facet pain is a common cause of persistent pain after a whiplash injury. Patients with neck pain usually do not have pain radiating all the way down the arm to the forearm of hand.

How long does the procedure take?

Depending upon the areas to be treated the procedure can take from about 30-60 minutes.

How is the procedure performed?

Since nerves cannot be seen on x-ray, the needles are positioned using bone landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. After confirmation of the needle tip position, a special needle tip is inserted. When the needle is in good position, as confirmed by x-ray, electrical stimulation is done using the radiofrequency machine before any lesioning. This stimulation may procedure a buzzing or tingling sedation or may be like hitting your “funny bone” You may also feel your muscles jump. You need to be awake during this part of the procedure so you can report what you are feeling.& The tissue surrounding the needle-tip are then heated when electronic current is passed using the Radiofrequency machine, for a few seconds. This “numbs” the nerves semi-permanently to permanently.
You will be lying on your stomach when working on the lower cervical and lumbar facet joints, or lumbar sympathetic nerves. You will be lying on your back when lesioning the upper cervical (neck) area (eg. Stellate Ganglion). Depending on which area the procedure is taking place, the skin is cleansed with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needles close to the small nerve branches that go to the painful joints.

Will I be “put out” for this procedure?

The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

Who should not have this injection?

If you are on a blood thinning medication (eg. Coumadin® , Heparin, Plavix®), or you are or could be pregnant, have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks you may not be a candidate for this.

How long will the effects of the procedure last?

If successful the effects of the procedure can last from 3 months to permanent but usually 6-12 months, and when this happens the procedure can be repeated, usually with good results again.

Can the procedure make me worse?

There is no reason for the procedure to make back pain worse, it does not change the spine. Patients occasionally have new numbness and sometimes burning pain near the treatment site that last up to a few months, but this is temporary. In our experience, an occasional patient reports worsening of their pain after the procedure but this is uncommon and it is not possible to say whether it is the procedure or simply the natural progression of their back pain causing the pain increase.

What are the risks and side effects?

Generally speaking this procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The risks and complications are dependent upon the sites that are lesioned. Anytime there is an injection through the skin; there is risk of infection. This is why sterile conditions are used for this procedure. The needles have to go through skin and soft tissues, which will cause soreness. The nerves to be lesioned may be near blood vessels or other nerves which can be potentially damaged. Great care is taken when placing the radio frequency needles but sometimes complications occur. Please discuss your specific concerns with you physician. Rarely, nerves near the target nerves can be accidentally injured causing pain, numbness, or weakness. This is very, very uncommon. If you are having a radio frequency sympathectomy, your hand or foot may feel warmer than you would like, or too dry (from decrease sweating).

What is a Sacro-iliac Joint Injection?
Sacro-iliac Joint Injection is an injection of a long-acting steroid in the sacro-iliac joint; a large joint in the low back and buttocks where the hip joint joins the spine.

What is the purpose of it?

The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain and swelling and thus, may improve mobility.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The most common side effect is pain, which is temporary. The other risks are related to the side effects of the steroid: these include weight gain, increase in blood sugar (mainly in diabetics), water retention, and suppression of the body’s own natural production of steroids. Fortunately, the serious side effects and complications are unusual.

How long does the injection take?

The injection takes approximately 7-10 minutes.

Will the injections hurt?

The procedure involves inserting a needle through the skin and deeper tissues (like a tetanus shot). There is some discomfort involved. We use a very thin needle and we numb the skin and deeper tissues with a local anesthetic prior to inserting the needle into the joint.

Will I be “put out” for this procedure?

The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

How is the injection performed?

You will be lying on your stomach, under x-ray. You are monitored with a blood oxygen-monitoring device. The skin on the buttock is cleansed with anti-septic solution and then the procedure is performed. After the injection, you will be assisted to the recovery area.

What can I expect after the procedure?

Immediately after the injection you may feel that your pain is gone or considerable less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have it for a day or two. You may start noticing pain relief starting the 3rd-7th day from the effects of the steroid and its effect can last for several days to a few months.

How many injections do I need to have?

If the first injection does not improve your symptoms in a week or two, we will usually not repeat the injection. If you respond to the injection and still have residual pain, you may be recommended for another injection.

Stellate Ganglion Injection is an injection to turn off “sympathetic nerve tissue”- the nerves which are a part of Sympathetic Nervous System. The nerves are located on either side of the voice box, in the neck.

What is the purpose of it?

The injection blocks the Sympathetic nerves. This may in turn reduce pain and swelling and thus, may improve mobility.

What is actually injected?

The injection consists of a local anesthetic (like Lidocaine or Bupivicaine) and occasionallly a small amount of steroid (Depo-Medrol and/or Sarapin, Celestone or Kenalog).

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The most common side effect is pain which is temporary. The other risks are very rare and include infection, bleeding, worsening of symptoms, etc.

How long does the injection take?

The injection takes approximately 7-10 minutes.

Will the injections hurt?

The procedure involves inserting a needle through the skin and deeper tissues (like a tetanus shot). There is some discomfort involved. We use a very thin needle.

Will I be “put out” for this procedure?

The use of sedation can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

How is the injection performed?

You will be lying on your back, under x-ray. You are monitored with a blood oxygen-monitoring device. The skin in front of the neck is cleaned with anti-septic solution and then the procedure is performed. After the injection, you will be assisted to the recovery area.

What can I expect after the procedure?

Immediately after the injection you may feel your upper extremity getting warm. In addition, you may notice that your pain is gone or considerably less. This is due to the local anesthetic injected. This may last only for a few hours. You may also notice some nasal congestion, lump in the throat and a hoarse voice. You should be able to return to work the next day.

How many injections do I need to have?

If the first injection does not improve your symptoms, we will usually not repeat the block. If you respond to the injections and still have residual pain, you may be recommended for another injection.

Trigger point injections are local injections of local anesthetics into areas of muscle spasm. Muscle spasms are an irritable or sensitive spot in the body the can be painful. Most often these spots are found in a muscle that is a knot or a tight band of muscle that fails to relax. The muscle spasm can also irritate or trap surrounding nerves and can then be felt in other areas of the body (referred pain).

This procedure is safe. However, with any procedure there are risks, side effects and the possibility of complications. The other risk involves bleeding, infections, spinal block and injection into blood vessels and surrounding nerves. Fortunately, the serious side effects and complications are uncommon.

How long does the injection take?

The actual injection takes only a few minutes.

How is the procedure actually performed and what is actually injected?

The area to be injected is cleansed with antiseptic solution and a small needle is used to enter the site of pain. Many different solutions can be injected; local anesthetic, small doses of steroid medications, and normal saline.

Will the injections hurt?

The procedure involves inserting a needle through the skin and deeper tissues (like a tetanus shot). There is some discomfort involved. We use a very tiny needle.

Will I be “put out” for this procedure?

The use of a sedating medication can be discussed with your doctor. Sedation has been used in some cases. If sedation is used, you MUST bring a driver. You will NOT be able to drive or operate machinery until the following day.

How long will the effects of the medication last?

The local injections will only numb the areas for a short time but the ability to undergo physical therapy, message, etc. may allow the painful cycle of muscle tension to be broken.

What can I expect after the procedure?

The painful sites will be numb, which can facilitate physical therapy, message or movement. You should be able to return to work the next day. The most common symptom you may feel is a sore muscle.